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Disorders of the Stomach High Yield Flashcards

1
Q

Hallmark sign of stomach disorder

A

Dyspepsia

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2
Q

3 main etiologies for erosive gastritis

A
  1. Meds (NSAIDs)
  2. Alcohol
  3. Stress
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3
Q

MC clinical manifestation of erosive gastritis

A

Upper GI Bleeding

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4
Q

Most sensitive method of diagnosing erosive gastritis

A

EGD

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5
Q

Tx of erosive gastritis

A
  1. Remove any causative agent
  2. Pantoprazole 80mg bolus + 8mg/hr infusion
  3. EGD within 24hrs
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6
Q

What EGD findings suggest erosive gastritis?

A
  1. Erythema
  2. Red/black mucosal lesions
  3. Petechial hemorrhages
  4. Presence of blood vessels
  5. Absence of rugal folds
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7
Q

Tx of NSAID gastritis

A

PPIs +/- sucralfate +/- celebrex

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8
Q

Best way to treat/prevent ulcers

A

PPIs

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9
Q

3 main etiologies for NONerosive gastritis?

A
  1. H pylori
  2. NSAIDs
  3. Autoimmune gastritis
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10
Q

MC demographic for H pylori infection

A

Children in crowded areas w/ poor sanitation

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11
Q

What 3 demographics have the most susceptibility to gastric metaplasia?

A
  • Hispanics
  • Native Americans
  • African Americans
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12
Q

Diagnosis of non-erosive gastritis

A

EGD w/ biopsy

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13
Q

Workup for pts < 60 w/o uncomplicated dyspepsia

A

Check for H. pylori via urea breath or fecal antigen.

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14
Q

Criteria to workup pt for non-erosive gastritis with EGD

A
  1. > 60 w/ new onset dyspepsia
  2. Young pts with alarm symptoms
  3. Failure of initial therapy
  4. FMHx of gastric cancer
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15
Q

Positive urea breath test

A

Expired CO2 contains tagged urea isotope

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16
Q

What antibody class is most useful for monitoring H pylori treatment?

A

IgG

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17
Q

1st therapy for H. pylori eradication

A
  1. PPI 20mg BID
  2. Clarithomycin 500mg BID
  3. Amoxicillin 1g BID

Please Cure Abdomen

10-14 days

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18
Q

2nd line therapy for H. pylori eradication

A
  1. PPI
  2. Metronidazole 500mg TID
  3. Tetracycline 500mg QID
  4. Bismuth 300mg QID

Please Make Tummy Better

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19
Q

What two spots does PUD occur in?

A
  • Duodenum
  • Stomach
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20
Q

Age range for stomach PUD

A

55-70

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21
Q

Age range for duodenal PUD

A

30-55

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22
Q

What layer is PUD

A

muscularis mucosa

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23
Q

3 main etiologies for PUD

A
  • H pylori (Duodenum)
  • NSAIDs (Stomach)
  • Zollinger Ellison
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24
Q

4 PUD risk factors

A
  1. NSAIDs
  2. Age > 60
  3. Prior PUD or H pylori
  4. Smoking
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25
Q

Hallmark signs of PUD

A
  1. Epigastric, gnawing pain that relieves with eating
  2. Nocturnal pain that wakes patient

11pm-3am MC time

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26
Q

Diagnosis of PUD

A

EGD with gastric mucosal biopsy

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27
Q

Noninvasive testing using fecal antigen or urea breath test criteria for PUD

A
  1. < 60 w/o no alarm
  2. Hx of PUD to diagnose active infections
  3. Checking post-treatment
  4. Biopsy inconclusive/not done w/ EGD
28
Q

Tx of PUD due to H. pylori

A

1st line H. pylori eradication tx for 10-14d

  1. PPI 20mg BID
  2. Clarithomycin 500mg BID
  3. Amoxicillin 1g BID

Please Cure Abdomen

29
Q

How to confirm H. pylori eradication?

A

EGD or urea breath test 4 weeks post therapy

30
Q

Criteria to CONTINUE meds post eradication therapy

A
  • Large ulcer > 2cm
  • Failed eradication
  • Recurrent ulcers
  • Continued NSAID use

Continue PPI for 4-6 weeks more

31
Q

Patient wants to continue NSAID even though they have NSAID induced PUD. Tx?

A
  • Use PPI as long as NSAID is used
  • Use celebrex instead
32
Q

MCC of UGI bleed

33
Q

Initial managment of a GI Bleed

A

Fluids and stabilize hemodynamic state

34
Q

1st med to give IV in GI bleed

35
Q

Hallmark sign of PUD w/ perforation

A

Sudden, severe abd pain

36
Q

Diagnosis of perforation

A

CT Abd showing free air in anterior peritoneal space or under diaphragm

37
Q

Management of PUD w/ perf

A

PPIs and surgery if not improved.

38
Q

Tx of gastric outlet obstruction

A
  1. IV PPI
  2. EGD
  3. Dilation via balloons
39
Q

Misoprostol MOA and BBW

A
  • MOA: Replace prostaglandins
  • BBW: will terminate pregnancy if taken
40
Q

MC SE of misoprostol

41
Q

What should be screened for prior to misoprostol administration?

A

Pregnancy test 2 weeks prior

42
Q

Sucralfate MOA and MC SE

A
  • MOA: Increased prostaglandin synthesis
  • SE: Constipation and affects absorption of other drugs
43
Q

Etiology of gastric outlet obstruction in babies

A

Postnatal hypertrophy of pylorus

44
Q

Hallmark symptoms of gastric outlet obstruction in adults? Infants?

A
  • Adults: Postprandial N/V
  • Infants: Projectile vomiting
45
Q

PE Findings for adult for gastric outlet obstruction? Infants?

A
  • Adults: distension, tenderness, succussion splash
  • Infants: distension, olive shaped mass in UR abd post-emesis, dehydration
46
Q

Diagnosis of adult gastric outlet obstruction? Infants?

A
  • Adults: EGD + CT
  • Infants: Abd US
47
Q

Adult management of gastric outlet obstruction?

A
  • NPO, fluids, NG tube, PPI
  • Pyloromyotomy if surgery needed
48
Q

MC demographics for gastroparesis

A
  • Women
  • Diabetics
49
Q

PE Findings in gastroparesis

A
  • Possible distension or tenderness
  • No guarding or rigidity
  • Possible succussion splash
50
Q

Diagnosis of gastroparesis

A

Gastric emptying test

51
Q

Management of gastroparesis

A
  • Low fat diet
  • Metoclopramide or erythromycin
  • Treat underlying cause
52
Q

Positive gastric emptying test result

A

> 10% retention after 4 hours

53
Q

Triad of Zollinger Ellison

A
  1. Gastrinomas (Pancreas or duodenum)
  2. Gastric acid hypersecretion
  3. Peptic ulcers
54
Q

Majority of zollinger-ellison ulcers are…

55
Q

Classic presentation of Zollinger-Ellison

A
  • Refractory PUD
  • Heartburn
  • Wt loss
  • Diarrhea
56
Q

Diagnosis of Zollinger Ellison

A
  1. Serum gastrin level > 10x ULN with pH < 2
  2. Positive gastrin must be confirmed with secretin stimulation

No PPIs 6 days prior

57
Q

Imaging modalities for Zollinger Ellison

A
  • CT/MRI to find tumors and mets
  • Somatostatin receptor scintigraphy to find primary tumor
58
Q

2 MC sites of mets for Zollinger Ellison

A
  1. Liver (MC)
  2. Bones
59
Q

How to improve Zollinger-Ellison survival

A

Resect liver mets

60
Q

Benign vs malignant gastric tumors

A
  • Benign: polyps
  • Malignant: adenocarcinoma (MC), lymphoma, carcinoid (zollinger-ellison)
61
Q

MC type of gastric cancer

A

Adenocarcinoma

Gland cells in stomach

62
Q

MC subtype of adenocarcinoma

A

Intestinal type adenocarcinoma

63
Q

3 mets sites (nodes) for adenocarcinoma

A
  1. L supraclavicular lymph node (Virchow’s)
  2. Umbilical nodule (Sister mary joseph)
  3. Rigid rectal shelf (Blumer shelf)
64
Q

Diagnosis of gastric adenocarcinoma

A

EGD w/ biopsy

CT for mets

65
Q

Tx of gastric adenocarcinomas

A
  1. Resect
  2. Chemo/radiation
66
Q

MC risk factor for gastric lymphoma

A

Chronic H. Pylori infection

67
Q

Diagnosis of gastric lymphoma

A

EGD w/ biopsy

GI (17 decks)

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